Therapy for Insomnia Helps Depression Recovery

Carey, Benedict, Pittsburgh Post-Gazette (Pittsburgh, PA)

NASHVILLE -- An insomnia therapy that scientists just reported
could double the effectiveness of depression treatment is not widely
available nor particularly well understood by psychiatrists or the
public. The American Board of Sleep Medicine has certified just 400
practitioners in the United States to administer it, and they are
sparse, even in big cities.

That may change soon, however. Four rigorous studies of the
treatment are nearing completion and due to be reported in coming
months. In the past year, the American Psychological Association
recognized sleep psychology as a specialty, and the Department of
Veterans Affairs began a program to train about 600 sleep
specialists. So-called insomnia disorder is defined as at least
three months of poor sleep that causes problems at work, at home or
in relationships.

The need is great: Depression is the most common mood disorder,
affecting some 18 million Americans in any given year, and most have
insomnia.

"I think it's increasingly likely that this kind of sleep therapy
will be used as a possible complement to standard care," said John
M. Oldham, chief of staff at the Menninger Clinic in Houston. "We
are the court of last resort for the most difficult-to-treat
patients, and I think sleep problems have been extremely
underrecognized as a critical factor."

The treatment, known as cognitive behavioral therapy for
insomnia, or CBT-I, is not widely available. Most insurers cover it,
and the rates for private practitioners are roughly the same as for
any psychotherapy, ranging from $100 to $250 an hour, depending on
the therapist.

"There aren't many of us doing this therapy," said Shelby Harris,
the director of the behavioral sleep medicine program at Montefiore
Medical Center in the Bronx, who also has a private practice in
Tarrytown, N.Y.

According to preliminary results, one of the four studies has
found that when CBT-I cures insomnia -- it does so 40 percent to 50
percent of the time, previous work suggests -- it powerfully
complements the effect of antidepressant drugs.

"There's been a huge recognition that insomnia cuts across a wide
variety of medical disorders, and there's a need to address it,"
said Michael T. Smith, a professor at the Johns Hopkins School of
Medicine and president of the Society of Behavioral Sleep Medicine. …

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